Tumours of the eyelid and conjunctiva
- Lesion
Most eyelid cancers are basal cell carcinomas; sebaceous carcinoma can look like a simple chalazion and must not be missed.
What it is
The eyelid is skin on the outside and conjunctiva on the inside, with specialised sebaceous (meibomian) glands between. Its tumours follow those of skin: basal cell carcinoma is by far the commonest, usually on the lower lid. Sebaceous carcinoma, rarer but more dangerous, mimics chalazion or chronic blepharitis and spreads within the epithelium. The conjunctiva gives rise at the limbus to squamous neoplasia (from dysplasia to carcinoma), melanocytic lesions (nevus, primary acquired melanosis, melanoma), lymphoma and Kaposi sarcoma.
Structure
- Chalazion, the main mimic: lipogranuloma around extruded sebum, with histiocytes and giant cells around clear lipid spaces.
- Xanthelasma: lipid-laden macrophages in the dermis of the inner lids; may signal dyslipidemia.
Tumours of the eyelid and conjunctiva
| Tumour | Usual site | Key histology | Behaviour |
|---|---|---|---|
| Basal cell carcinoma | Lower lid, medial canthus | Basaloid nests with palisading | Locally invasive |
| Sebaceous carcinoma | Upper lid | Vacuolated cells, pagetoid spread | Can metastasise; mimics chalazion |
| Squamous cell carcinoma of the lid | Lower lid | Keratinising squamous cells | Local and nodal spread |
| Ocular surface squamous neoplasia | Limbus | Dysplasia to invasive carcinoma | Recurs; rarely metastasises |
| Conjunctival melanoma | Bulbar, fornix or palpebral conjunctiva | Atypical melanocytes | Regional nodes, distant spread |
| Conjunctival lymphoma | Fornix, salmon patch | Monoclonal B cells (MALT) | Indolent |
| Kaposi sarcoma | Conjunctiva or lid | Spindle cells, slit-like vessels, HHV-8 | Linked to HIV |
Markers
- Adipophilin and EMA (sebaceous carcinoma)
- BerEP4 (basal cell carcinoma)
- SOX10, HMB-45, Melan-A (melanoma)
- HHV-8 LANA (Kaposi sarcoma)
Clinical notes
- A lid lesion with loss of lashes, ulceration or recurrence is biopsied.
- Sun protection lowers the risk of eyelid and conjunctival cancers, important in high-altitude equatorial regions.
Test yourself
Think of the answer, then tap the question to see it.
What is the most common malignant tumour of the eyelid?
Basal cell carcinoma, usually on the lower lid.
Why can sebaceous carcinoma be missed?
It mimics a chalazion or chronic blepharitis and spreads within the epithelium (pagetoid spread).
Where do conjunctival squamous and melanocytic neoplasms usually start?
At the limbus, the junction of cornea and conjunctiva, which holds epithelial stem cells.
Elsewhere in DurgiPedia
Connections
Microorganisms1
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Chalazion (StatPearls (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.